National Institute for Health and Clinical Excellence (NICE)
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Older patients at high risk of hospital falls

Healthcare professionals should consider patients aged 65 or older, and those aged over 50 with underlying conditions such as stroke, at high risk of falling while in hospital care, according to updated guidelines from NICE.

Falling is the leading cause of injury-related admissions to hospital in those over 65, and costs the NHS an estimated £2.3 billion per year.

A number of falls occur in hospitals, with nearly 209,000 reported between 1 October and 30 September 2012.

While many who fall only experience minor cuts or bruises, over the past year 90 people died, and around 900 experienced hip fractures and head injuries as a result of falls.

NICE has updated its guidelines on falls, to help reduce the number of older people who are falling over in hospitals.

NICE says that certain groups of inpatients should be regarded as being at risk of falling in hospital. These include all patients aged 65 years or older, and those aged 50 to 64 years who are judged by a clinician to be at higher risk of falling because of an underlying condition such as dementia or stroke.

For these patients, aspects of the inpatient environment that could affect their risk of falling should be systematically identified and addressed. These include flooring, lighting, furniture and fittings such as hand holds.

Healthcare professionals should also consider a multifactorial assessment and multifactorial intervention for patients at risk of falling in hospital.

These assessments should identify a patient's individual risk factors for falling in hospital that can be treated, improved or managed during their expected stay.

Such risk factors may include cognitive impairment, continence problems, a history of falls, postural instability and visual impairment.

Healthcare professionals should ensure that any multifactorial intervention carried out should promptly address the patient's identified individual risk factors for falling in hospital, and take into account whether the risk factors can be improved managed or treated during the patient's expected stay.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: "Falling over is a serious problem in hospitals, and unfortunately their likelihood increases with age as people become frailer. They can cause distress, pain, injury, a loss of confidence and independence, and in some cases, death."

He added: “While it would be virtually impossible to prevent all hospital falls from happening, our guideline calls for doctors and nurses to address the issues that will reduce the risk of their patients suffering avoidable harm. No two patients are the same and so a “one size fits all” approach will not work."

Michelle Mitchell, Director General of Age UK said: "The consequences of a fall in later life can be physically and emotionally devastating, potentially resulting in loss of mobility, independence and confidence.

"In addition to the pain caused to the individual, falls cost around £6 million a day in hospital and social care costs to treat."

He added: "Implementing these new guidelines to reduce falls in hospitals must be a priority for our health service, not only to improve patient safety, but to help save precious NHS resources."

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